Examination finding | Definition | Clinical concern raised |
Anthropometrics | ||
Short stature or unexplained decrease in height velocity | Height <50th percentile with weight >95th percentile* (if not explained by familial short stature) Growth velocity <5 cm/year in a prepubertal child, or declining across over 2 or more height percentile curves on a standard chart (eg, decreasing from the 90th to the 50th percentile) | Endocrine or genetic condition (eg, Cushing syndrome) |
Vital signs | ||
Hypertension | Hypertension if systolic or diastolic blood pressure >95th percentile for age, gender, and height on ≥3 occasions | Primary hypertension, renal disease, or Cushing syndrome |
Skin | ||
Acanthosis nigricans | Hyperpigmented, thickened, velvety skin in body folds and creases, particularly neck | Suggests insulin resistance and increased risk for type 2 diabetes |
Excessive acne, hirsutism, oligo- or amenorrhea | Hirsutism is an abnormal amount of sexual hair that appears in a male pattern (eg, face and neck) | Polycystic ovary syndrome |
Violaceous striae | Linear lesions that are red, pink, or purple in color, particularly on the abdomen | Cushing syndrome |
HEENT | ||
Papilledema, cranial nerve VI paralysis | Optic disc swelling on funduscopic examination, caused by increased intracranial pressure | Pseudotumor cerebri (idiopathic intracranial hypertension) |
Tonsillar hypertrophy | Tonsils occupy more than 50% of the lateral dimension of oropharynx | Obstructive sleep apnea |
Goiter | Enlarged or swollen thyroid gland | Hypothyroidism |
Chest | ||
Wheezing | High-pitched whistling on auscultation | Asthma |
Abdomen | ||
Hepatomegaly, right upper quadrant tenderness | Increased liver span | Nonalcoholic fatty liver disease or gallstones |
Genitourinary | ||
Micropenis | Unusually small penis | In most cases, the small-appearing penis is actually normal size; the length is buried under suprapubic fat Some endocrinologic or monogenic forms of obesity are associated with hypogonadism and undervirilization in males |
Undescended testes | Testicle not palpable in scrotum | Prader-Willi syndrome |
Precocious puberty | Secondary sex characteristic development that is inappropriate for chronological age | Hypothalamic-pituitary lesion, including for ROHHAD/ROHHADNET syndrome Children with Prader-Willi syndrome often have premature pubarche (due to adrenarche) but not precocious puberty |
Musculoskeletal | ||
Abnormal gait, limp, pain in hip or groin, limited range of motion in hip | Slipped capital femoral epiphysis | |
Genu varum (bow legs) or genu valgus (knock-knees) | Abnormal tibio-femoral angle | Mild deformities may be physiologic in children <6 years; in older children, these are associated with excessive weight Clinically significant genu varum is known as Blount disease |
Small hands and feet, or polydactyly | Genetic condition (eg, Prader-Willi syndrome or Bardet-Biedl syndrome) |